Foot Health

Feeling Better May Be Foot Related

Your feet play a key role in maintaining your health. We invited experts in the field to help make sense of how your feet affect your overall health. These experts also complied a glossary to define some of the common foot health issues.

If you are experiencing pain, the Superfeet design may help alleviate your discomfort, but we always recommend consulting a physician to find out if our products are right for you.

Glossary

Achilles Tendonitis

The Achilles tendon is the tendon that attaches the calf muscle (the combination of the gastrocnemius muscle and the soleus muscle) to the heel bone (calcaneus). It is one of the strongest tendons in the body and is required to do a lot of work, particularly during athletic activities.

There are many causes of Achilles tendonitis and it is seen in people with all different foot types. Most often, the cause of Achilles tendonitis can be linked to increasing activities over a short period of time, particularly increasing running, walking or hiking distances too quickly before the tendon can develop the strength and flexibility to adapt to the new activity. This is called overuse Achilles tendonitis.

Achilles tendonitis also happens frequently in runners who perform their training in sturdy training shoes with elevated heels (all running training shoes), and then do a race or fast training in a race flat or spike that often has little to no heel elevation. This causes the Achilles tendons to have to stretch up to an inch more than they were used to, due to the training shoe artificially elevating the heel. Couple this with the fact that most races are also run at a faster pace than training and you now have two factors that will increase the likelihood of developing Achilles tendonitis.

The same situation is seen in women who usually wear shoes with high heels and then attempt to wear a shoe with a lower heel. The Achilles tendon is placed under additional stress that it is not used to and it becomes inflamed.

Achilles tendonitis can affect any part of the tendon, but most commonly affects the tendon at its insertion on the heel bone or just a few centimeters above the insertion.

Shoes that rub on the back of the heel can irritate the Achilles tendon and back of the heel bone that can be considered traumatic Achilles tendonitis, but sometimes is called a pump bump. Only removing the cause of the inflammation will relieve the pain and inflammation encountered in this situation, which are the shoes. This can occur if the shoe is too short in heel to toe length, the shape of the heel counter (the rounded cup-shaped part of the shoe that covers the back of the heel) doesn't match the shape of the heel, or if there is too much motion of the heel bone during walking and activities which causes it to rub on the shoe. This is often easily determined by looking in the inside of the heel counter of the shoe to see if the material has been worn away by the back of the heel bone. This type of Achilles tendonitis or pump bump (so called because of the rubbing of the back of the heel bone by dress pumps) responds well to wearing clogs of backless sandals that put no pressure on the area until the area heels. Once the area heels, the individual will need to have their shoes and boots professionally fitted to prevent this painful problem.

Tendonitis responds to PRICE: Protection, Rest, Ice, Compression and Elevation. Protection - protect the tendon from shoes that rub on it. Rest - rest the tendon by not participating in the activities that caused the tendon to become inflamed until the signs of inflammation are gone. Ice - ice the area of inflammation for 6-10 minutes several times per day. Compression - compress the swollen part of the tendon with the use of an Ace (all cotton elastic) wrap or ankle brace. Elevation - elevate the tendon above the heart to help decrease the swelling.

Achilles tendonitis is a serious injury and should be treated immediately, since prolonged and untreated inflammation can cause the problem to become chronic and allow scar tissue to form within the tendon, which decreases its flexibility and increases the chances of complete rupture (tearing away from the bone or tearing in two pieces).

In flexible foot types, an insole or an orthotic with a deep heel cup may eliminate some of the excessive motion of the heel bone, which aggravates the tendon.

Calf and Achilles strengthening exercises are showing promising results for resistant cases of Achilles tendonitis. The exercises consist of dropping the heels lower than the forefoot, which causes the Achilles tendon to contract, but get longer at the same time. This type of muscle contraction is called an eccentric (the muscle gets longer while it is contracting) contraction. As the individual gets stronger, progressively more weight is added to cause more of an Achilles stretch and thus a greater eccentric contraction. An athletic trainer or physical therapist is an excellent resource for help with this treatment.

Arches - Flat (Flat Feet)

When the foot pronates and collapses, the arch begins to lower or flatten to the ground and puts stress on the muscles, tendons and ligaments.

Many things can create pain in the arch of the foot and over-pronation is one of them. When the foot pronates and collapses, the arch begins to lower or flatten to the ground and puts stress on the muscles, tendons and ligaments. If the foot stretches the plantar fascia ligament on the bottom of the foot, it can radiate pain throughout the arch area.

There are many situations where arch pain may occur and a great place to start when looking for relief is with a good insole. The insole can help encapsulate the soft tissue around the bottom of the foot for shock absorption and comfort. It can also add increased stability, support and performance to the bone structure of the foot so the foot can function as it was intended to do so when we walk or run.

Arches - High

In regards to high arches, the bone structure is more like a tripod and when you stand on the foot, you are actually standing on the bony prominences of the bottom of the foot.

If a high arch exists in the foot, there may be some forefoot pain associated with that due to the fact that the foot is like a tripod. There is a lot of pressure on the bony prominences of the bottom of the foot at the heel bone and at the five metatarsal bones in the forefoot area.

One of the arch's many functions in the foot is to transmit energy from the rearfoot to the forefoot. It is also designed to have some movement for adaptation and shock absorption.

It is more common that a high arch will be much more stable and stronger than a low arch, or a flat foot.

The goal of the insole in regards to high arches would be to fill some of the voids on the bottom of the foot to offer some support. It is not always necessary that the insole or the orthotic fill the arch completely in a matter that it may lift it, twist it, or jam the foot.

In some situations, if you have an extremely high arch, it is recommended to get a custom orthotic. The insole or orthotic is designed to accommodate the height and the depth of the arch.

Many people talk about arch support and the need to fill or lift the arch. Ideally, it is best to accommodate to the foot shape in the arch area. What this means is that we do not want to build a high arch support in the center of the foot so that a teeter-totter or a bridge exists in the middle of the foot. This does not offer the proper support in the rearfoot, or the proper support in the toe area of the foot.

Ideally, the goal is to support the biggest bone in the foot first, which is the heel bone, then accommodate and support the remaining structure of the foot.

Back Pain

The first question you might ask yourself is "What do feet have to do with the lower back?" The feet are the foundation for the whole body, very much like a foundation for a house.

If you properly support the foundation, the structure above it can function in the manner it was designed to work in.

If the foot excessively pronates or collapses, that internally rotates the lower shaft of the leg (the tibia and fibula). It internally rotates the knee, the thighbone (the femur) and can rotate and drop the hip on one side. At the same time, as the hip rotates, it is connected to the low back. This rotation can start to form a curvature in the lower back.

When the feet are properly supported and centered, the amount of rotation in the lower extremity and the hips is reduced, taking stress off and helping to realign the lower back.

As the skeletal structure of the lower extremity is realigned by the use of an insole, it also takes the stress and fatigue off many of the tendons, muscles and ligaments that are involved with the ankle, knee, hip and lower back.

Superfeet insoles can have a great effect on the posture of the body. Proper posture alignment starts when the foot hits the ground. When we have a good foundation underneath the body, the body can be maintained in its ideal functioning position.

It is important to give the insoles a chance to adapt to the body and the shoe. It is equally important to give the body a chance to adapt to the insoles. Any aches and pains felt in the body probably did not occur overnight and therefore will not disappear overnight. Healing takes time and patience.

A Superfeet insoles can help improve the lower back and continue to work up through the mid-back and the neck.

Simply put, the foot bone is connected to the ankle bone, the ankle bone is connected to the knee bone, the knee bone is connected to the thigh bone, the thigh bone is connected to the hip bone, the hip bone is connected to the back bone, and so on.

Bunions

Bunions are generally located behind the joint of the big toe and the first large metatarsal bone in the forefoot area. This is the area where the foot flexes in the front.

There can be smaller bunions that develop on the foot, at the outside of the foot, behind the little toe, and the fifth metatarsal bone (which is a much smaller bone). These are commonly referred to as "bunionettes" on the outside of the foot.

The most common is the very large formation bunion at the ball of the foot.

Many people that think bunions are hereditary. In actuality, it's not the bunion that is hereditary; it is the amount of pronation that exists in the rearfoot that is hereditary. This would be the amount of pronation that you are born with.

The bunion is simply the symptom of the excessive pronation that exists in the rearfoot.

Whenever you have excessive motion, stress and pressure on a bone in a joint area in the foot, the foot will counteract that, first with fluids and soft tissue inflammation. Secondly, bone will start to grow. So anytime you add friction to the surface of a bone it will start to become enlarged.

Anytime that you add direct force and pressure to a joint or bone where the blood flow is cut off and there is not movement, you will have deterioration of the joint or bone and it will get smaller.

When a bunion appears, that lets you know immediately that you have excessive motion, instability, and friction around that area.

Many people that think high heels and the shape of the high heel's pointed toe are the cause of bunions. In reality, it is ill-fitting shoes and the shape of the shoe itself that accelerates the process and the growth of the bunion.

There are a number of male individuals that have bunions on their feet that have never even worn a high heel shoe, or a shoe that has a pointed toe like a cowboy boot. So it is not fair to say that it is the high heel shoe that creates the bunions. It is the shoe shape and style that accelerates the whole process although the bunion probably exists before they even get into that type of shoe style.

Because it is pronation in the rearfoot that triggers the bunion, it is very important to use a good insole or an orthotic to stabilize the rearfoot so that the forefoot and the ball of the foot area are stable. This will help to reduce any excessive motion or friction at the ball of the foot.

It is equally important to make sure that the shoe has plenty of room around the associated bunion area so that the shoe does not add any increased friction, rubbing or pressure at the ball of the foot.

Bunions can be removed surgically. But what is equally important is to make sure that after the surgery an orthotic is made for the foot, or a proper insole is used to stabilize the foot.

After bunions have been surgically removed, it is possible for them to re-occur later on. Generally this happens more often when there has not been the introduction of a corrective orthotic or a good supportive insole after the bunion surgery.

Again, you must understand that it is the pronation of the rearfoot that predisposes the forefoot to bunion symptoms, so you must treat the cause first, before you treat the symptoms.

Diabetes

If you have problems with diabetes, we recommend that you consult your medical doctor in regards to using the Superfeet product.

Superfeet products are not recommended if somebody is having problems with their feet related to diabetes.

There have been many people that are classified Grade I and Grade II diabetic, and the Superfeet product has performed tremendously well for this level of diabetes. When the diabetes level is Grade III, Grade IV, or greater you must consult a medical professional specializing in the feet in regards to their recommendation of what type of footwear or insole should be used for your particular situation.

Flat Foot

Flatfoot is also called pes valgus, or pes plano valgus. It has many causes and it often runs in families.

Some of the causes are nerve problems called neuromuscular disorders, like cerebral palsy. People with extremely flexible soft tissue structures often have flatfeet, the so-called double-jointed person. Achilles tendons that are too tight will flatten out the foot. This is called EQUINUS( equinogenic flatfoot ). TARSAL COALITION (bones growing together that should be separate in the joints in the back of the foot) of the STJ and MTJ will often produce a flat foot. Flat feet can be flexible and floppy or they can be without much motion called rigid, such as occurs in tarsal coalitions.

Not all flat feet have problems, yet some of the worst foot problems are often associated with flat feet. Consider posterior tibial dysfunction. Family history is very important.

Treatment for flatfeet depends on the cause of the flatfoot and the associated symptoms and likelihood of progression. Early in the course of treatment, supportive devices are often placed in the shoe to favorably position the arch and try to modify the symptoms and progression. If the flattening is minor, perhaps less control is necessary and likely a non-prescription orthotic will be beneficial. As the degree of flattening increases, the likelihood of needing a custom device increases and will often be augmented with bracing that comes above the ankle. If the flatfoot is thought to be caused by a tight Achilles tendon and calf muscle (equinus), stretching exercises are often encouraged to attempt to achieve more flexibility in the back of the lower leg. Since dropping the back of the heel will increase the stretch within the tendon and muscle, effectiveness of stretching programs will be negated by wearing shoes that have a heel that is held above the forefoot. This is called a positive heel position and is the opposite of what you wish to train the back of your lower leg to do. If you have an equinogenic flatfoot, wearing a shoe with a heel that is elevated above the front part of the shoe is accelerating your deformity. You want to progressively lower the back of your heel over your lifetime, so look for low-heeled shoes and if you can tolerate it without getting hurt, look for a shoe with a negative heel, the so-called Earth Shoe.

If you are unable to achieve flexibility in your Achilles and calf and it is thought to be the cause of your foot troubles, you may get a surgical recommendation to lengthen your Achilles tendon. Make sure to exhaust all attempts at conservative care prior to undergoing an Achilles tendon lengthening.

Hammertoes

Hammertoes are a situation where the tendons that are attached on top of the toes contract back, shortening the toe in length and raising the knuckle of the toe. This type of condition can be approached in a number of different ways.

One of the first considerations is to evaluate the shoe and boot volume and determine if there is enough room in the toe box of the shoes or boots so that the tops of the toes do not rub on the shoe or boot, creating blisters, corns, calluses and that sort of thing.

This is generally a very simple modification that can be made to the shoe or boot, increasing the height of the toe box, giving the toes the room that they need so that there is no undue pressure put on the tops of the toes.

Superfeet footbeds can help this situation by stabilizing the foot so that there is less friction and sliding around of the foot inside the shoe or boot, reducing the chance of blistering the tops of the toes.

If after the shoe or boot has been modified and problems still exist, it is recommended that you consult a foot doctor or a medical specialist that specializes in feet and follow their recommendations on how to treat the situation.

In some cases, corrective orthotics can help hammertoe situations by the modifications that they build into the corrective orthotic to help straighten the toes out.

In some situations, the hammertoes can be surgically altered. It is recommended that you consult a foot specialist and get a corrective orthotic, or have a surgical procedure done to take care of the problem. It is always a good idea to modify all of the footwear so that your foot has the volume it needs inside the shoe.

Heel Pain - Plantar Fasciitis

Plantar fasciitis not only creates pain in the heel region of the foot; it can cause arch pain.

Plantar fasciitis is the inflammation and possible tears of the plantar fascia ligament that attaches to the base of the heel bone on the bottom of the foot. The ligament extends to the metatarsal heads in the forefoot area. The plantar fascia ligament is very much like a guitar string when it is pulled tight.

Plantar fasciitis not only creates pain in the heel region of the foot; it can cause arch pain. It can be triggered by a number of different situations.

One of the most common situations that triggers plantar fasciitis is over-pronation within the foot. If the foot pronates, collapses and elongates it actually pulls on this ligament and stretches it. It is this pulling motion and stretching motion that takes place in the 8,000 to 12,000 steps we take per day. As we walk, that puts stress on the plantar fascia ligament and triggers it to become inflamed and possibly start to tear.

There are certainly other situations that can trigger plantar fasciitis, like wearing a shoe that may not be the right shape, or offer the right amount of support, or certain types of impacts to the bottom of the foot. Those impacts may put pressure on the plantar fascia ligament causing it to become bruised or stressed.

Plantar fasciitis is commonly treated with an insole or orthotic in the beginning to try to stabilize the bone structure of the foot so that the plantar fascia ligament can stay more relaxed and undue stress is not put on the ligament.

It is very important in plantar fasciitis situations to wear a very good, stable shoe that offers the foot support. More importantly, it needs to have a very good, supportive insole or orthotic. It will help the foot function properly with minimal amount of stress on the foot.

Superfeet does not claim that it can cure plantar fasciitis. There are many different variables involved with each individual such as how far along the plantar fasciitis is, where it is located within the ligament and all the other variables such as shoes, environment, body weight, range of motion within the foot and the amount of time the individual spends standing, running or working on their feet.

An insole is certainly an excellent place to start the healing process.

Heel Spurs

Heel spurs are generally located on the bottom surface of the heel bone. In some situations they may actually be located on the bottom side portion of the heel bone. Sometimes they aren't exactly shaped like what they are referred to, as a little spur on the bottom of the bone.

There have been situations where you can be born with a heel spur or heel spurs can be developed. Heel spurs may grow on the heel bone due to a number of situations, such as impact to the bottom of the heel bone and motion or friction primarily in the area of the heel bone.

A heel spur is a type of bone growth that develops on the outside of the bone. It may have a small hook shape to it and they are generally located, but not always, where the plantar fascia ligament attaches to the bottom of the heel bone.

In some situations, the heel spur can be on the inside of the heel bone or on the opposite side, the outside of the heel bone.

Heel spurs are most commonly treated by the use of a corrective orthotic or stabilizing insole such as Superfeet. Depending on how severe the heel spur is and the size of the spur, they can also be treated surgically by having the heel spur surgically removed. Cortisone injections may also be helpful.

The heel spur, because it is part of the bone, has no feeling in it. The pain that is generated from the heel spur is due to the soft tissue around the heel spur that is irritated, inflamed and bruised.

One of the ways to try to alleviate heel spur pain is with the use of an insole or orthotic. The function of the insole is to try to reposition the heel bone so that it reduces excessive motion within the area of the foot where the spur is located.

If you can properly support the heel bone so that friction and motion are reduced, it will allow the soft tissue around the area of the heel spur to heal and have a reduction in the inflammation and tenderness.

The goal would be to support the heel bone enough so that the heel spur does not dig into the soft tissue. This is achieved by using an insole with a deep heel cup and proper shape along with other supporting features around the product and the foot.

It is also very important to support the soft tissue around the foot, keeping it cupped, and help to hold it in position so it can add more cushioning capabilities around the tender area of the heel.

The heel spur, depending on where it is located, does not necessarily generate pain. There have been some instances where individuals have had heel spurs and did not realize it.

It is very important when a heel spur exists to not only have a good, supportive insole with a deep heel cup, but also equally important is to have a supportive shoe with a strong heel counter around the back of the shoe to give the foot and insole added support so they can function properly as a complete system.

Iliotibial Band Syndrome

This tendonitis/syndrome is characterized by pain which is localized over the lateral femoral condyle (outer knee), which may radiate to the proximal tibia area.

Initially the discomfort is relieved by rest, and the condition is worsened with continued activity. Usually it is caused by overuse and training errors by the athlete. Often it is due to inadequate stretching and can frequently develop during downhill running. Other factors include excessive pronation, tight heel cords, genu varum (bowl legged), and malignment of the foot. Treatment consists of rest, ice, compression and elevation initially, then stretching and consideration of functional orthotics and shoe recommendations. Training issues may also need to be addressed.

Knee Pain

The feet can have a dramatic effect on knee pain.

If you are experiencing knee pain, one recommendation is to have it properly diagnosed by a physician that specializes in knees.

The feet can have a dramatic effect on knee pain. The foot can be a predisposing factor in knee stress, strain and discomfort based on the fact that the foot bone is connected to the ankle bone, and the ankle bone is connected to the leg bone, the leg bone is connected to the knee bone, and the knee bone is connected to the hip bone, and so on.

As we walk and the foot excessively pronates, it internally rotates and twists the knee. With eight to twelve thousand steps a day, this rotation over a period of time can start to put stress, fatigue and strain on the knee region.

Often individuals will seek out medical attention to treat the symptoms, but they don't realize that the cause of the symptoms may exist in the foot. If you stabilize the foot with an insole like Superfeet, you can reduce knee stress and pain by reducing the amount of rotation in the knee area.

There have been situations where people will choose to try an insole, to either make the shoe more comfortable or help to make the foot more comfortable, and it may create knee pain. If this is the case, it is recommended that you take the Superfeet insoles out and do not use them until you consult your doctor regarding the knee pain and its cause.

Some of this knee pain from using the insole is aggravated because the foot and knee are used to being in one position. As you introduce the insole into the arch system of the body and it changes the alignment of the knee, the net result of that change may be knee discomfort.

Although, in most situations when knee pain exists, the Superfeet insole or corrective orthotic will add comfort and help to reduce the strain and stress in this area.

Metatarsalgia

This is a very common word that is used when there is forefoot pain evident in the foot. Metatarsalgia is almost like a tendonitis within the forefoot.

It is primarily inflamed soft tissue in the area of the forefoot. It may also be associated with stresses, inflammation and fatigue of the muscles, tendons and ligaments in the metatarsal region of the forefoot.

Some of the considerations for metatarsalgia would be a good insole that offers the foot support. A supportive shoe that flexes in the proper place would also be helpful.

In other words, the shoe needs to flex where the foot flexes. If the shoe does not flex at the ball of the foot where the foot flexes it will put more stress on the forefoot region of the foot; possibly creating symptoms like metatarsalgia.

It is also important to make sure that the shoe has the proper width so that it is not squeezing the metatarsal bones and nerves together, reducing the amount of blood and oxygen that can get to that region of the foot.

Morton's Neuroma

A neuroma is a sometimes-painful nerve enlargement of one of the nerves of the body. When it occurs within the foot, it usually happens in one of the nerves going to the toes in the forefoot.

The nerve that a neuroma most commonly forms within is called the intermetatarsal nerve and is one of the many branches within the foot that have traveled from the spine. A neuroma can occur between any of the long bones (metatarsals) in the forefoot, but is most commonly encountered in the intermetatarsal nerve between the third and fourth metatarsals and toes. This is a Morton's neuroma as described Dr. Morton almost 100 years ago. If a neuroma occurs between any of the other long bones, it is not called a Morton's neuroma, but is just called a neuroma. Neur or neuro stands for nerve, and oma stands for swelling or tumor. Simply stated, a neuroma is a swelling or enlargement of a nerve. The word tumor should be discouraged from being applied to a neuroma, since tumor could be construed to mean cancerous or malignant. Neuromas are benign and often respond to conservative care.

Conservative treatment is first geared towards finding shoes that allows the forefoot to spread and not be confined. High-heeled shoes aggravate neuromas on two counts. They generally squeeze the intermetatarsal nerves and cause the wearer to bear weight directly on the nerve which is being stretched across the ball of the foot. This trauma is also encountered in shoes not considered high heeled by most of the population. A shoe with any heel and any lift in the front of the shoe (called toe spring) will place more stress on the nerves and predispose to formation of a neuroma.

To find a shoe that has enough room in the forefoot, choose a shoe with a removable liner or insole and stand on it, to see if your foot is wider than the liner. If it is, the shoe will aggravate the neuroma by squeezing the metatarsal bones together. If you have a flexible foot, an insole or orthotic will decrease the amount of spreading and motion that your forefoot can undergo. This is one of the reasons why orthotics are prescribed for neuromas. It is extremely important for those with neuromas to understand that by using an orthotic or insole, they will automatically need a larger and often wider sized shoe, because the supportive device will take up some room in the shoe. In this instance, foot care providers should choose the thinnest device possible and possibly not use a full-length device. A favorite is the carbon graphite devices fabricated by Northwest Podiatric Labs of Blaine, Washington. If choosing a Superfeet insole for a neuroma, it is possible to cut off the front of the insole to give the forefoot more room within the shoe or boot.

If the wider shoe and supportive device do not help with your neuroma, you may seek out a metatarsal pad to be placed on your insole or ask your foot care provider to put one on your orthotic. This pad will spread the metatarsal bones and remove pressure from the nerve where it goes under the ball of the foot. The placement of the metatarsal pad is of utmost importance and is best placed by a foot care provider with experience in the anatomy of the forefoot and the treatment of neuromas.

Other conservative remedies are ice therapy and anti-inflammatory medications. If the above measures have not helped, foot care providers will sometimes inject cortisone around the nerve to decrease the size and inflammation from the trauma. Injections of concentrated alcohol around the nerve have also shown good results and should be considered prior to undergoing surgery (neurectomy), which is a removal of the enlarged, traumatized portion of the nerve. X-rays of the affected foot will not show a neuroma as nerve does not show up on x-ray studies, but they are helpful to determine if OSTEOARTHRITIS or STRESS FRACTURE are causing the symptoms. Ultrasonography and MRI are sometimes used to make the diagnosis. The clinical examination by a foot care specialist with experience treating neuromas will be the best way to diagnose a neuroma. The examiner will attempt to duplicate neuroma symptoms by pressing on the nerve at various locations and may try to produce a clicking of the nerve, which will occur in skilled hands, if the nerve has enlarged.

Shoes are the main cause of neuromas, those struggling with the symptoms of a neuroma should seek out professional shoe fitting.

Those with a neuroma describe several different types of sensations. Burning, stinging, stabbing, shooting, tingling, cramping, numbness, fullness and walking on a lump, as if their sock is wadded or bunched up in the front of their shoe. Many will find near immediate relief of symptoms by removing their shoe/shoes. This should be taken as confirmation that one should carefully assess the shoes they wear and their fit.

Dr. McClanahan believes the toe spring (toe box of shoe elevated above ground) and tapering (pointed in the front) toe boxes are the most common causes of neuromas, especially when they are components of the high heeled shoe.

Over Pronation

The foot goes through many different ranges of motion. One of these motions is referred to as pronation.

Pronation is the ability of the foot to adapt to uneven terrain as well as to offer some shock absorption when the foot strikes the ground. Pronation is a very important function for the foot when it is properly maintained.

Eighty percent of the population pronates more than they need to in order to function properly. By using the proper type of insole, you can increase stability to the excessive pronation within the foot.

The goal of the Superfeet insoles or a corrective orthotic would be to try to slow the pronation motions down so that these types of forces don't aggravate or injure the muscles, tendons, ligaments and bones in the lower extremity.

The insole is actually trying to control the amount of pronation that is taking place within the foot. By controlling the excessive pronation within the foot, the body can be much more efficient and pain-free.

Plantar Fasciitis

Plantar fasciitis is the inflammation and possible tears of the plantar fascia ligament that attaches to the base of the heel bone on the bottom of the foot.

The ligament extends to the metatarsal heads in the forefoot area. The plantar fascia ligament is very much like a guitar string when it is pulled tight.

Plantar fasciitis not only creates pain in the heel region of the foot; it can also cause arch pain and can be triggered by a number of different situations.

One of the most common triggers of plantar fasciitis is excessive pronation within the foot. If the foot pronates (tilts inward), collapses and elongates, it pulls on this ligament and stretches it. It is this pulling and stretching motion that takes place in the 8,000-12,000 steps we take per day that puts stress on the plantar fascia ligament and causes it to become inflamed and possibly start to tear.

There are other situations that can trigger plantar fasciitis, like wearing a shoe that isn't the right shape or doesn't offer the right amount of support, or certain types of impact to the bottom of the foot. High impact may put pressure on the plantar fascia ligament, causing it to become bruised or stressed.

Plantar fasciitis is commonly treated with an insole or orthotic in an attempt to stabilize the bone structure of the foot. By supporting the bones in the foot, elongation and pronation are reduced. This helps the plantar fascia remain relaxed without placing undue stress on the ligament.

It is important in plantar fasciitis situations to wear a very stable shoe that offers the foot a lot of support. More importantly, wearing a supportive insole or orthotic inside stable shoes will help the foot function properly with the least amount of stress on the foot.

Superfeet does not claim that it can cure plantar fasciitis. There are many different variables involved in each case such as how far along the plantar fasciitis is, where it is located within the ligament, what type of shoes are being worn, environment, body weight, range of motion within the foot and the amount of time the individual spends standing, running or working on their feet. There are also other methods of reducing pain from plantar fasciitis like icing and stretching the calves and tendons.

But a supportive insole is certainly an excellent place to start the healing process.

Posterior Tibial Tendonitis

The posterior tibial muscle originates on the back of the lower leg, deep to the calf muscle.

As it courses down the leg, it comes around the inside back of the ankle, under the inside ankle bone (medial malleolus) and attaches to the navicular bone and most of the bones in the middle part of the foot. When it contracts, it inverts the foot, so it functions to help support the arch and resist arch collapse. In other words, it resists the foot and arch from undergoing too much pronation, sometimes termed over pronation.

When the posterior tibial tendon develops inflammation, it needs the same prescription of PRICE (protection, rest, ice, compression, elevation) as well as a trip to the foot care provider for treatment which may consist of taping to temporarily splinting of the foot, ankle and lower leg in a position of inversion to rest the tendon. Non-prescription and prescription orthotics play valuable roles in the prevention of the posterior tibial tendonitis becoming a more serious problem which we call POSTERIOR TIBIAL DYSFUNCTION (PTD), or acquired flatfoot.

This occurs when the posterior tibial muscle and tendon have become weakened or stretched out to the point that they no longer are able to resist the arch collapsing (over pronating) and the foot becomes flat.

When this happens, it is extremely difficult for the person to rise up on the toes of the affected foot without feeling excruciating pain in the arch. Many people with PTD are unable to accomplish this maneuver. The foot takes on the çToo many toes signå we foot care providers like to talk about, which is what we see when we stand behind people who have this tendon problem. We see their toes pointing to the outside of the foot rather than straight ahead as would be seen in the normal foot. This makes sense, as this foot has been allowed to maximally pronate, and if you consider the manifestation of pronation within the forefoot, it is forefoot abduction (away from the midline or great toe).

Reviewing pronation, there is eversion of the rearfoot, which means the top of the heel bone rolls towards the inside, dorsiflexion and abduction of the forefoot. PTD is a maximally pronated, flattened, collapsed foot with the back of the foot going to the inside and the front of the foot going to the outside. A miserable, difficult foot to fit in shoe gear, that becomes progressively more difficult to treat, the flatter and more misshapen it becomes. For this reason, those with flat or flexible feet, a family history of PTD or posterior tibial tendonitis should seek out the care of a foot care provider with experience treating PTD. This likely will also be someone with experience in the understanding and fabrication of foot orthotics. If the foot is not collapsed, it may respond favorably to non-prescription orthotics and the aforementioned PRICE. Sometimes anti-inflammatory medications are offered orally or topically. Steroid preparations (cortisone like medicines) such as dexamethasone can be applied locally as well with a treatment called iontophoresis, which uses electrical current to help your body absorb these medicines. Injectable steroids (corticosteroids) are not generally recommended due to the possibility that they may cause complete rupture of the inflamed and weakened tendon. If an insole, arch support or orthotic are part of your treatment plan, make sure to maximize the ability of those supportive devices to resist arch flattening by wearing supportive boots that come above the ankle joint. That will go a long way towards inhibiting the affects of arch flattening on your ankle, lower leg and knee. If you suffer from PTD, do yourself a favor by throwing fashion out the window and dedicate yourself to choosing your footwear based on how it feels with the supportive device and not how it looks. As you can imagine from the previous statement, this condition is encountered more frequently in women, as is the case with most foot conditions.

If your foot (PTD occurs more frequently on one side only) or feet collapse, you need immediate attention, because failure to get treatment leaves you with fewer options. Advanced cases generally require wearing restrictive braces that come up the lower leg above the ankle or surgical procedures aimed at getting the foot to be straight and the arch to be elevated. These procedures often involve the use of arthrodesis (fusion techniques), which remove the painful joint or joints and join two or more bones artificially with hardware (screws, plates, pins, wire, etc.). The joints most commonly fused are the rearfoot joints, where the majority of the eversion, dorsiflexion and abduction (the components of pronation) originate. These are the SUBTALAR JOINT (STJ) and MIDTARSAL JOINT (MTJ). The subtalar joint is the joint below the ankle joint. Its cartilage separates the calcaneus (heel bone) from the talus (bone above the calcaneus and below the tibia).

The MTJ is actually two separate joints that work in concert with one another and the STJ while the foot pronates and supinates. They are the calcaneocuboid joint and the talonavicular joints. These joint complexes allow the foot to be the incredible adapter that it must be to perform all of the functions that it performs, on all of the varied surfaces that it carries us over. Permanently restricting the foot from ever performing these motions again is never the best option, due to the fact that the joints above and below the fusions are now called upon to do more than they were intended to and to move unnaturally. OSTEOARTHRITIS (DEGENERATIVE JOINT DISEASE) is expected earlier than usual in those overworked joints.

Fortunately, with regular foot checkups and proper awareness of one's family foot history, this debilitating foot deformity can often be prevented.

Sever's Disease

Sever's disease is not a disease at all. It is an inflammation of the growth plate in the heel bone which leads to pain in the heel.

It occurs in children and adolescents who are active, and is more common in boys than girls. It is caused by the tugging action of the Achilles tendon at one end of the growth plate and the plantar fascia at the other. Generally, the Achilles and plantar fascia are pulling excessively in an attempt to stabilize the foot. Treatment can consist of heel cups, therapeutic exercises and orthotics.

KAREN A LANGONE, DPMFellow of the American College of Podiatric Sports Medicine

Shin Splints

Shin splints generally occur in the lower section of the leg around the shinbone. Shin splints are commonly known as the muscle attachment of the lower leg tearing away from the bone.

As the bones in the feet and leg rotate, the muscle gets stretched and the muscle attachment around the bone starts to separate, creating soft tissue pain. If the shock and tearing continues, it can turn into some stress fractures within the bone, which are very small bone fractures.

Generally, when you have the area x-rayed in regard to a stress fracture or shin splints, the area affected might not show up on x-ray until four to six weeks later. At that time there will be new bone growth within the small stress fractures of the bone, which shows up on x-rays much clearer. It is much easier to diagnose stress fractures or shin splint problems after the healing process has started to take place.

In regards to a solution for chronic shin splint problems, an insole plays a very important role because it helps to reduce the amount of rotation that the lower leg goes through, taking the stresses off of the muscles of the affected area.

If you support the insoles with an athletic style shoe that offers some shock absorbing capabilities, the insoles and the shoe can work together as one component to help to stabilize the lower extremity and take stresses and shock off of the shin area so that the leg can have the proper support to begin to heal itself.

Stress Fractures

A common question that we are asked at Superfeet is "Will the insoles help stress fracture situations?"

Superfeet cannot state that the insole product will actually help a stress fracture. This is because it depends on where the stress fracture exists, how large it is and how long it has been in existence. There are a number of variables that affect the situation.

Although by simply stabilizing the foot with the Superfeet insole and following the insole up with a stable shoe, you can help to absorb shock within the foot and lower extremity, therefore reducing some of the stresses on the bones within the feet and lower extremity.

It is not uncommon to have runners complain about stress fractures. There are some instances where there is a type of shoe that a particular runner is used to running in, and the body is accustomed to in regards to its adaptation to the shoe. Runners can actually create some stress fractures when they change brands or the style of shoe that they are currently running in.

Sometimes when this change takes place it will reposition the bones in the foot and lower extremity. It may, in some instances, actually create some stress fractures, as there was not adequate time for the break-in process to take place. There may also be some other reasons for the stress fracture to occur, but it is not uncommon to hear runners complain about stress fractures when they have changed some of their running shoes.

The body does adapt and get used to certain shoes, orthotics and insoles; therefore, when a change is made, the body may act in a negative manner, or it may react in a positive manner.

When an orthotic or Superfeet insole is placed inside the shoe, the goal of the device is to help stabilize the skeletal structure within the foot, and properly position the bones within the foot so they can function at their full extent. This will help to take stresses off the muscles, tendons and ligaments. It will also reduce some of the stress on the bones.

If you have the right shape under the foot, cradling and supporting the foot, you will get the proper function.

One of the goals in dealing with stress fractures is to try to help absorb the shock when the foot hits the ground. If you properly position the bones in the feet, the shock can enter the foot at heel-strike, go through the proper joints in the foot, and exit the foot at toe-off with much greater efficiency.

If the shock is allowed to enter and exit the foot properly, the shock will spend less time within the foot structure, therefore reducing the potential for the shock to fatigue or damage the foot. If the shock is allowed to spend extended periods of time within the foot, it can do more damage to the foot. Although the foot has to deal with shock when it hits the ground, the knee is the main shock-absorbing joint for the body. If we align the foot properly, that will offer better knee alignment for better shock absorption.

Preventative situations for stress fractures would be first, to use a good insole. Secondly, make sure that the shoe is properly supporting the foot for the activities and sports that you are involved in.